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(eBook PDF) Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness 14th Edition
LAB 2.1 Safety of Exercise Participation: PAR-Q+ 51
LAB 2.2 Overcoming Barriers to Being Active 55
LAB 2.3 Using a Fitness Tracker or Smartphone Exercise App to Measure Physical Activity 59
LAB 3.1 Assessing Your Current Level of Cardiorespiratory Endurance 89
LAB 3.2 Developing an Exercise Program for Cardiorespiratory Endurance 97
LAB 4.1 Assessing Your Current Level of Muscular Strength 135
LAB 4.2 Assessing Your Current Level of Muscular Endurance 141
LAB 4.3 Designing and Monitoring a Strength Training Program 145
LAB 5.1 Assessing Your Current Level of Flexibility 169
LAB 5.2 Creating a Personalized Program for Developing Flexibility 175
LAB 5.3 Assessing Muscular Endurance for Low-Back Health 177
LAB 6.1 Assessing Body Mass Index and Body Composition 195
LAB 6.2 Setting Goals for Target Body Weight 203
LAB 7.1 A Personal Fitness Program Plan and Agreement 227
LAB 7.2 Getting to Know Your Fitness Facility 229
LAB 8.1 Your Daily Diet versus MyPlate 273
LAB 8.2 Dietary Analysis 275
LAB 8.3 Informed Food Choices 277
LAB 9.1 Calculating Daily Energy Needs 303
LAB 9.2 Identifying Weight-Loss Goals 305
LAB 9.3 Checking for Body Image Problems and Eating Disorders 307
LAB 10.1 Identifying Your Stress Level and Key Stressors 339
LAB 10.2 Stress-Management Techniques 341
LAB 10.3 Evaluating and Improving Sleep 343
LAB 11.1 Cardiovascular Health 367
LAB 12.1 Cancer Prevention 389
LAB 13.1 Is Alcohol a Problem in Your Life? 415
LAB 13.2 For Smokers Only: Why Do You Smoke? 417
LAB 14.1 Behaviors and Attitudes Related to STIs 437
LAB 15.1 Environmental Health Checklist 461 The Behavior Change Workbook and the laboratory activities are also found in an interactive format in Connect (connect.mheducation.com).
LEARN WITHOUT LIMITS
McGraw-Hill Connect® is a reliable, easy-to-use homework and learning management solution that uses learning science and award-winning adaptive tools to improve student results. Connect’s assignments help students contextualize what they’ve learned through application, so they can better understand the material and think critically. Connect content is available through a simple and intuitive interface. Connect for Fit & Well offers a wealth of interactive online content, including fitness labs and self-assessments, video activities on timely health topics and exercise techniques, a behavior change workbook, and practice quizzes with immediate feedback.
New to this edition are assignable and assessable Concept Clips, which help students master key fitness and wellness concepts. Using colorful animation and easy-to-understand audio narration, Concept Clips provide step-by-step presentations to promote student comprehension; topics covered include the stages of change model, types of diabetes, and the stress response. Also new are NewsFlash activities, which tie current news stories to key fitness and wellness concepts. After interacting with a contemporary news story, students are assessed on their understanding and their ability to make the connections
between real-life events and course content. Examples of NewsFlash topics include food fads, stress and obesity, and factors affecting life expectancy.
Connect Insight® is a visual analytics dashboard—now available for both instructors and students—that provides immediately actionable, at-a-glance information to empower learners and help improve student performance. Connect Insight presents assignment, assessment, and topical performance results along with a time metric that is easily visible for aggregate or individual results. Using robust visual data displays that are each framed by an intuitive question, Connect Insight gives both instructors and students the ability to take a just-in-time approach to teaching and learning. By providing actionable recommendations, Connect Insight guides students toward behaviors that could increase performance and enables instructors to give targeted tuition precisely when and where it is needed.
Available within Connect, SmartBook® makes study time as productive and efficient as possible by identifying and closing knowledge gaps. SmartBook is powered by the proven LearnSmart® engine, which identifies what an individual student knows and doesn’t know based on the student’s confidence level, responses to questions, and other factors. LearnSmart builds an optimal, personalized learning path for each student, so students spend less time on concepts they already understand and more time on those they don’t. As a student engages with SmartBook, the reading experience continuously adapts by highlighting the most impactful content a student needs to learn at that moment in time. Students can enjoy convenient, anywhere, anytime access to SmartBook via iOS and Android tablet and smartphone apps.
PROVEN, SCIENCE-BASED CONTENT
The digital teaching and learning tools within Connect are built on the solid foundation of Fit & Well’s authoritative, science-based content. Fit & Well is written by experts who work and teach in the fields of exercise science, physical education, and health education. Fit & Well provides accurate, reliable current information on key health and fitness topics while also addressing issues related to mind-body health, diversity, research, and consumer health.
Wellness in the Digital Age sections focus on the many fitness- and wellnessrelated devices and applications that are appearing every day.
Diversity Matters features address the ways that our biological and cultural differences influence our health strengths, risks, and behaviors.
Evidence for Exercise sections demonstrate that physical activity and exercise recommendations are based on solid scientific evidence.
Critical Consumer boxes help students navigate the numerous and diverse set of health-related products currently available.
Take Charge features provide a wealth of practical advice for students on how to apply concepts from the text to their own lives.
Fitness Tips and Wellness Tips catch students’ attention and get them thinking about—and acting to improve—their fitness and wellness.
Hands-on lab activities give students the opportunity to assess their current level of fitness and wellness and to create their own individualized programs for improvement.
Exercise photos and online videos demonstrate exactly how to correctly perform exercises described in the text.
Changes to the 13th edition reflect new research findings, updated statistics, and current hot topics that impact students’ fitness and wellness behaviors. Revisions were also guided by student performance data collected anonymously from the tens of thousands of students who have used LearnSmart with Fit & Well. Because virtually every text paragraph is tied to several questions that students answer while using LearnSmart, the specific concepts that students are having the most difficulty with can be pinpointed through empirical data.
CHAPTER-BY-CHAPTER CHANGES
Chapter 1: Introduction to Wellness, Fitness, and Lifestyle Management
• New Wellness in the Digital Age feature about health behavior tracking apps
• New information on the obesity epidemic and life expectancy, on the costs of cardiovascular disease (CVD), and on the importance of exercise in reducing CVD risk
• Updated statistics on leading causes of death, key contributors to death among Americans, changes in life expectancy, progress toward Healthy People 2020 targets, and health problems among college students
Chapter 2: Principles of Physical Fitness
• Updated American College of Sports Medicine (ACSM) recommendations for frequency, intensity, time, type, volume, and progression (FITT-VP) for fitness programs
• New and updated information on benefits of fitness, on exercise as a means for reducing anxiety, and on good nutritional choices to support an exercise program
• New information on digital workout aids in the Wellness in the Digital Age feature and on fitness trackers in Lab 2.3
• New Physical Activity Readiness Questionnaire for Everyone (PAR-Q+) in Lab 2.1
Chapter 3: Cardiorespiratory Endurance
• New and expanded information on the cardiorespiratory system, on the benefits of endurance exercise, and on applying the FITT-VP principle
• Updated discussion and illustration of ratings of perceived exertion (RPE), including the 0–10 scale
• Updated Wellness in the Digital Age feature about fitness trackers, heart rate monitors, and GPS devices
Chapter
4:
Muscular Strength and Endurance
• New section on supplements and drugs, including cautions related to anabolic steroids
• New program planning table that includes major muscles, their functions, and related strength training exercises
• Updated coverage of the FITT-VP principle, weight training safety, strength training apps, and the McGill curl-up technique
Chapter 5: Flexibility and Low-Back Health
• Updated information on joint health and on exercises for low-back health
• Updated information on applying the FITT-VP principle to stretching programs
Chapter 6: Body Composition
• Updated statistics on obesity rates and trends in the United States; updated information on the complex relationship between energy intake and body weight
• Expanded discussion of factors that limit the accuracy of body mass index (BMI) as a tool for classifying health risks
Chapter 7: Putting Together a Complete Fitness Program
• New section on exercise guidelines for people with special health concerns (formerly in an appendix)
• Updated information on smartphone apps that support an exercise program
Chapter 8: Nutrition
• New information on the 2015–2020 Dietary Guidelines for Americans; the FDA’s nutrition facts and food package nutrient claims; and the USDA’s MyPlate and recommended food patterns
• New Take Charge feature with specific recommendations for how to meet the Dietary Guidelines
• New tables focused on dietary fiber and major dietary guidelines; new figure comparing the current U.S. diet versus recommendations
• New and updated information on added sugars, benefits of dietary fiber, nutrient density, the relationship between fats and health, and vegetarian diets
Chapter 9: Weight Management
• Updated discussion on the health effects of overweight/ obesity; includes a new figure on the relationship between BMI and mortality
• New material on environmental and physiological factors that affect body composition, as well as how changes in metabolic rate affect weight loss and maintenance
• New information on energy balance and updated discussion of lifestyle factors that affect body fat and body weight
• New Critical Consumer feature on research into dietary patterns that promote weight loss; new Take Charge feature on techniques for being active during screen time
Chapter 10: Stress Management and Sleep
• New major section on sleep and its role in stress, including the biology of sleep, a new figure on the stages of sleep, sleep drivers, and features on overcoming insomnia and how digital devices affect sleep
• New Lab 10.3: Evaluating and Improving Sleep
• New Diversity Matters feature on diverse populations, discrimination, and stress; new Take Charge feature on mindfulness meditation
Chapter 11: Cardiovascular Health and Diabetes
• Expanded coverage of diabetes, including a new illustration of the underlying processes of normal and disrupted metabolism
• Updated statistics and information on cardiovascular disease (CVD) types, heart-healthy diet recommendations, and tobacco use and CVD, including e-cigarettes
Chapter 12: Cancer
• New illustration of the stages in the development and spread of cancer; new material on genetic changes that contribute to cancer risk and on treatment innovations
• Updated statistics on cancer cases and deaths, and updated recommendations on mammography and breast awareness and on HPV vaccination
• New Common Questions Answered section on the types of cancers most common in young adults
Chapter 13: Substance Use and Misuse
• New sections on how the American Psychiatric Association defines and identifies substance misuse and addiction; on opioids and drug overdose deaths; and on evaluating the severity of alcohol use disorder
• Expanded discussion of addictive behaviors, including Internet gaming disorder, and compulsive exercising
• Updated statistics and information on nonmedical drug use among Americans, medical marijuana, rates of binge drinking, and rates of tobacco use
Chapter 14: Sexually Transmitted Infections
• Updated statistics on major STIs, HIV/AIDS, HIV transmission, and use of condoms by college students
• Updated Diversity Matters feature on the global HIV/ AIDS epidemic; updated Critical Consumer feature on HIV testing
Chapter 15: Environmental Health
• Updated statistics on world population growth, components of solid waste, and the hole in the ozone layer
• Updated information about the greenhouse effect and global warming, including the primary economic sectors responsible for emission of greenhouse gases
• New information on lead poisoning and the drinking water crisis in Flint, Michigan
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ACKNOWLEDGMENTS
Fit & Well has benefited from the thoughtful commentary, expert knowledge, and helpful suggestions of many people. We are deeply grateful for their participation in the project.
Academic Advisors and Reviewers
Ari B. Fisher, Louisiana State University
Brandy Schneider, Truman State University
Ellen Garrison, University of North Carolina Asheville
Greg Bullock, William Carey University
McGraw-Hill Campus® is a groundbreaking service that puts world-class digital learning resources just a click away for all faculty and students. All faculty—whether or not they use a McGraw-Hill title—can instantly browse, search, and access the entire library of McGraw-Hill instructional resources and services, including eBooks, test banks, PowerPoint slides, animations and learning objects—from any Learning Management System (LMS), at no additional cost to an institution. Users also have single sign-on access to McGraw-Hill digital platforms, including Connect, Create, and Tegrity, a fully automated lecture caption solution.
INSTRUCTOR RESOURCES
Instructor resources available through Connect for Fit & Well include a course integrator guide, test bank, image bank, and PowerPoint presentations for each chapter.
Jamie L. Famiglietti, Indiana University Bloomington
Karen K. Dennis, Illinois State University
Phyllis Eckler, Los Angeles City College
Rick Canter, Longwood University
Ronnie Nespeca, Lone Star College
Shinya Takahashi, University of Nebraska
Shrehan Lynch, University of Alabama
Teresa Moore, University of South Carolina
Virginia Trummer, University of Texas San Antonio
1
Introduction to Wellness, Fitness, and Lifestyle Management
LOOKING AHEAD...
After reading this chapter, you should be able to
■ Describe the dimensions of wellness.
■ Identify the major health and lifestyle problems in the United States today.
■ Describe the behaviors that are part of a wellness lifestyle.
■ Explain the steps in creating a behavior management plan.
■ Evaluate some of the available sources of wellness information.
TEST YOUR KNOWLEDGE
1. Which of the following lifestyle factors is the leading preventable cause of death for Americans?
a. excess alcohol consumption
b. cigarette smoking
c. obesity
2. The terms health and wellness mean the same thing. True or false?
3. A person’s genetic makeup determines whether he or she will develop certain diseases (such as breast cancer), regardless of that person’s health habits. True or false?
See answers on the next page.
Hero Images/Getty Images RF
Acollege sophomore sets the following goals for herself:
• Join new social circles and make new friends whenever possible.
• Exercise every day.
• Clean up trash and plant trees in blighted neighborhoods in her community.
These goals may seem unrelated, but they have one thing in common. Each contributes, in its own way, to this student’s health and well-being. Not satisfied merely to be free of illness, she wants more. She has decided to live actively and fully—not just to be healthy, but to pursue a state of overall wellness.
WEllnEss: nEW HEAlTH goAls
Generations of people have viewed health simply as the absence of disease, and that view largely prevails today. The word health typically refers to the overall condition of a person’s body or mind and to the presence or absence of illness or injury. Wellness expands this idea of health to include our ability to achieve optimal health. Beyond the simple presence or absence of disease, wellness refers to optimal health and vitality—to living life to its fullest. Although we use the terms health and wellness interchangeably, they differ in two important ways:
Answers (Test Your Knowledge)
1. b. Smoking causes about 480,000 deaths per year. Obesity is responsible for as many as 400,000 premature deaths, and alcohol is a factor in 90,000 deaths per year.
2. False. Although the words are used interchangeably, they have different meanings. The term health refers to the overall condition of the body or mind and to the presence or absence of illness or injury. The term wellness refers to optimal health and vitality, encompassing all the dimensions of well-being.
3. False. In many cases, behavior can tip the balance toward good health even when heredity or environment is a negative factor.
• Health—or some aspects of it—can be determined or influenced by factors beyond your control, such as your genes, age, and family history. For example, a man with a family history of prostate cancer will have a higher-thanaverage risk for developing prostate cancer.
• Wellness is largely determined by the decisions you make about how you live. That same man can reduce his risk of cancer by eating sensibly, exercising, and having regular screening tests. Even if he develops the disease, he may still reduce its effects and live a rich, meaningful life. This means not only caring for himself physically, but also maintaining a positive outlook, keeping up his relationships with others, challenging himself intellectually, and nurturing other aspects of his life.
Wellness, therefore, involves making conscious decisions to control risk factors that contribute to disease or injury. Age and family history are risk factors you cannot control. Behaviors such as exercising, eating a healthy diet, and choosing not to smoke are well within your control.
The Dimensions of Wellness
Here are nine dimensions of wellness:
• Physical
• Emotional
• Intellectual
• Interpersonal
• Cultural
• Spiritual
• Environmental
• Financial
• Occupational
Each dimension affects the others. Furthermore, the process of achieving wellness is constant and dynamic (Figure 1.1), involving change and growth. Ignoring any dimension of wellness can have harmful effects on your life. The following
FIGURE 1.1 The wellness continuum. The concept of wellness includes vitality in nine interrelated dimensions, all of which contribute to overall wellness.
Malaise
PHYSICAL WELLNESS
• Eating well
• Exercising
• Avoiding harmful habits
• Practicing safer sex
• Recognizing symptoms of disease
• Getting regular checkups
• Avoiding injuries
INTERPERSONAL WELLNESS
• Communication skills
• Capacity for intimacy
• Ability to establish and maintain satisfying relationships
• Ability to cultivate a support system of friends and family
ENVIRONMENTAL WELLNESS
• Having abundant, clean natural resources
• Maintaining sustainable development
• Recycling whenever possible
• Reducing pollution and waste
EMOTIONAL WELLNESS
• Optimism
• Trust
• Self-esteem
• Self-acceptance
• Self-confidence
• Ability to understand and accept one’s feelings
• Ability to share feelings with others
CULTURAL WELLNESS
• Creating relationships with those who are di erent from you
• Maintaining and valuing your own cultural identity
• Avoiding stereotyping based on ethnicity, gender, religion, or sexual orientation
FINANCIAL WELLNESS
• Having a basic understanding of how money works
• Living within one’s means
• Avoiding debt, especially for unnecessary items
• Saving for the future and for emergencies
sections briefly introduce the dimensions of wellness. Figure 1.2 lists specific qualities and behaviors associated with each dimension. Lab 1.1 will help you learn what wellness means to you and where you fall on the wellness continuum.
Physical Wellness Your physical wellness includes not just your body’s overall condition and the absence of disease but also your fitness level and your ability to care for yourself. The higher your fitness level, the higher your level of physical wellness will be. Similarly, as you take better care of your own physical needs, you ensure greater physical wellness. To achieve optimum physical wellness, you need to make choices that help you avoid illnesses and injuries. The decisions you make now—and the habits you develop over your lifetime— will largely determine the length and quality of your life.
Emotional Wellness Your emotional wellness reflects your ability to understand and deal with your feelings. Emotional wellness involves attending to your own thoughts and feelings, monitoring your reactions, and identifying obstacles to emotional stability. Self-acceptance is your personal satisfaction with yourself, which might exclude society’s expectations, whereas self-esteem relates to the way you think others perceive you. Self-confidence can be a part of both acceptance and esteem. Achieving this type of wellness means
INTELLECTUAL WELLNESS
• Openness to new ideas
• Capacity to question
• Ability to think critically
• Motivation to master new skills
• Sense of humor
• Creativity
• Curiosity
• Lifelong learning
SPIRITUAL WELLNESS
• Capacity for love
• Compassion
• Forgiveness
• Altruism
• Joy and fulfillment
• Caring for others
• Sense of meaning and purpose
• Sense of belonging to something greater than oneself
OCCUPATIONAL WELLNESS
• Enjoying what you do
• Feeling valued by your manager
• Building satisfying relationships with coworkers
• Taking advantage of opportunities to learn and be challenged
finding solutions to emotional problems, with professional help if necessary.
Intellectual Wellness Those who enjoy intellectual wellness continually challenge their minds. An active mind is essential to wellness because it detects problems and finds solutions. People who enjoy intellectual wellness never stop learning. They seek out and relish new experiences and challenges.
Interpersonal Wellness Satisfying and supportive relationships are important to physical and emotional wellness. Learning good communication skills, developing the capacity for intimacy, and cultivating a supportive network are all important to interpersonal (or social) wellness. Social wellness requires participating in and contributing to your community and to society.
health The overall condition of body or mind and the presence or absence of illness or injury.
TERMS
wellness Optimal health and vitality, encompassing all dimensions of well-being.
risk factor A condition that increases one’s chances of disease or injury.
FIGURE 1.2 Qualities and behaviors associated with the dimensions of wellness.
Wellness Tip
Enhancing one dimension of wellness can have positive effects on others. For example, joining a meditation group can help you enhance your spiritual well-being, but it can also affect the emotional and interpersonal dimensions of wellness by enabling you to meet new people and develop new friendships.
Cultural Wellness Cultural wellness refers to the way you interact with others who are different from you in terms of ethnicity, religion, gender, sexual orientation, age, and customs (practices). It involves creating relationships with others and suspending judgment on others’ behavior until you have lived with them or “walked in their shoes.” It also includes accepting, valuing, and even celebrating the different cultural ways people interact in the world. The extent to which you maintain and value cultural identities is one measure of cultural wellness.
Spiritual Wellness To enjoy spiritual wellness is to possess a set of guiding beliefs, principles, or values that give meaning and purpose to your life, especially in difficult times. The well person uses spirituality to focus on positive aspects of life and to fend off negative feelings such as cynicism, anger, and pessimism. Organized religions help many people develop spiritual health. Religion, however, is not the only source or form of spiritual wellness. Many people find meaning and purpose in their lives on their own— through nature, art, meditation, or good works—or with their loved ones.
Environmental Wellness Your environmental wellness is defined by the livability of your surroundings. Personal health depends on the health of the planet—from the safety of the food supply to the degree of violence in society. To improve your environmental wellness, you can learn about and protect yourself against hazards in your surroundings and work to make your world a cleaner and safer place.
Financial Wellness Financial wellness refers to your ability to live within your means and manage your money in a way that gives you peace of mind. It includes balancing your income and expenses, staying out of debt, saving for the future, and understanding your emotions related to money. For more on this topic, see the box “Financial Wellness”.
Occupational Wellness Occupational wellness refers to the level of happiness and fulfillment you gain through your work. Although high salaries and prestigious titles are gratifying, they alone do not bring about occupational wellness. An occupationally well person likes his or her work, feels a connection with others in the workplace, and takes advantage of opportunities to learn and be challenged. Another important aspect of occupational wellness is recognition from managers and colleagues. An ideal job draws on your interests and passions, as well as your vocational skills, and allows you to feel that you are making a contribution.
New Opportunities for Taking Charge
One hundred and sixty-five years ago, Americans considered themselves lucky just to survive to adulthood. A boy born in 1850, for example, could expect to live only about 38 years, and a girl, 40 years. Many people died from common infectious diseases (such as pneumonia, tuberculosis, or diarrhea) and poor environmental conditions (such as water pollution and poor sanitation).
infectious disease A disease that can spread from person to person; caused by microorganisms such as bacteria and viruses.
By 2015, however, life expectancy nearly doubled, to 78.8 years (Figure 1.3). This increase in life span is due largely to the development of vaccines and antibiotics to fight infections, and to public health measures to improve living conditions. But even though life expectancy has increased, poor health limits most Americans’ activities during the last
Researchers surveyed nearly 90,000 college students about their financial behaviors and attitudes. According to results released in 2016, a large percentage of students feel less prepared to manage their money than to handle almost any other aspect of college life. They also express distress over their current and future financial decisions. Front and center in their minds is how to manage student loan debt. Financial wellness means having a healthy relationship with money. Here are strategies for establishing that relationship:
Follow a Budget
A budget is a way of tracking where your money goes and making sure you’re spending it on the things that are most important to you. To start one, list your monthly income and your expenditures. If you aren’t sure where you spend your money, track your expenses for a few weeks or a month. Then organize them into categories, such as housing, food, transportation, entertainment, services, personal care, clothes, books and school supplies, health care, credit card and loan payments, and miscellaneous. Knowing where your money goes is the first step in gaining control of it.
Be Wary of Credit Cards
Students have easy access to credit but little training in finances. The percentage of students who have access to credit cards has increased from 28% in 2012 to 41% in 2015. This increase in credit card use has also correlated with an increase in paying credit card bills late, paying only the minimum amount, and having larger total outstanding credit balances. Shifting away from using credit cards and toward using debit cards is a good strategy for staying out of debt. Familiarity with financial terminology helps as well. Basic financial literacy with using credit cards involves understanding terms like APR (annual percentage rate—the interest you’re charged on your balance), credit limit (the maximum amount you can borrow), minimum monthly payment (the smallest payment your creditor will accept each month), grace period (the number of days you have to pay your bill before interest or penalties are charged), and over-the-limit and late fees (the amounts you’ll be charged if you go over your credit limit or your payment is late).
Manage Your Debt and Get Politically Active
A 2016 study indicated that the average student loan debt was $37,000—and this number is expected to rise. When it comes to student loans, having a personal plan for repayment can save time and money, reduce stress, and help you prepare for the future. However, only about 10% of students surveyed feel they have all the information needed to pay off their loans. Work with your lender and make sure you know how to access your balance, when to start repayment, how to make payments, what your repayment plan options are, and what to do if you have trouble making payments. Information on managing federal student loans is available from (https://studentaid.ed.gov/sa/).
Your student debt may reflect circumstances beyond your control. For example, financial aid programs may require
students to hold down jobs while also maintaining certain grade point averages. Consider contacting policymakers and asking them to pass measures to help students in need. One suggestion is for the Free Application for Federal Student Aid (FAFSA) to take into account how much debt a family or student already has when determining how much aid to grant.
Start Saving
If you start saving early, the same miracle of compound interest that locks you into years of credit card debt can work to your benefit (for an online compound interest calculator, visit http://www .interestcalc.org). Experts recommend “paying yourself first” every month—that is, putting some money into savings before you start paying your bills, depending on what your budget allows. You may want to save for a large purchase, or you may even be looking ahead to retirement. If you work for a company with a 401(k) retirement plan, contribute as much as you can every pay period.
Become Financially Literate
Most Americans have not received basic financial training. For this reason, the U.S. government has established the Financial Literacy and Education Commission (MyMoney .gov) to help Americans learn how to save, invest, and manage money better. Developing lifelong financial skills should begin in early adulthood, during the college years, if not earlier, as money-management experience appears to have a more direct effect on financial knowledge than does education. For example, when tested on their basic financial literacy, students who had checking accounts had higher scores than those who did not.
SOURCES: Smith, C., & G. A. Barboza. 2013. The role of trans-generational financial knowledge and self-reported financial literacy on borrowing practices and debt accumulation of college students. Social Science Electronic Publishing, Inc. (http://ssrn.com/abstract=2342168); Plymouth State University. 2013. Student Monetary Awareness and Responsibility Today! Plymouth State University. (http://www.plymouth.edu/office/financialaid/smart/); U.S. Financial Literacy and Education Commission, MyMoney. gov, 2013. (http://www.mymoney.gov); Mitchell, J., “Student Debt Is About to Set Another Record, But the Picture Isn’t All Bad,” Wall Street Journal, May 2, 2016. (https://blogs.wsj.com/economics/2016/05/02/studentdebt-is-about-to-set-another-record-but-the-picture-isnt-all-bad/); and EverFi, Money Matters on Campus: Examining Financial Attitudes and Behaviors of Two-Year and Four-Year College Students. www .moneymattersoncampus.org.
FIGURE 1.3 Public health and life expectancy of Americans from birth, 1900–2015. Public health achievements during the 20th century are credited with adding more than 25 years to life expectancy for Americans, greatly improving quality of life, and dramatically reducing deaths from infectious diseases. Public health improvements continue into the 21st century, including greater roadway safety, a steep decline in childhood lead poisoning, and an expansion of health insurance coverage.
SOURCES: Xu, J., et al. 2016. “Mortality in the United States, 2015,” NCHS Data Brief, No. 267; Centers for Disease Control and Prevention. “Ten great public health achievements—United States, 2001–2010,” MMWR 60(19): 619–623; Centers for Disease Control and Prevention 1999. “Ten great public health achievements—United States, 1900–1999,” MMWR 48(50): 1141.
10–15% of their lives, resulting in some sort of impaired life (Figure 1.4).
Today, a different set of diseases has emerged as our major health threat: Heart disease, cancer, and chronic lower respiratory diseases are now the three leading causes of death for Americans (Table 1.1). While life expectancy has consistently increased each decade in the United States since 1850, the rate of improvement has slowed (and as of 2015 actually dropped for the first time in decades). A recent increase in deaths from heart disease, stroke, and diabetes may be linked to the obesity epidemic that began in the late 1970s. Medical treatments may be reaching their limits in treating heart disease and in preventing other early deaths related to obesity. Moreover, people are becoming obese at earlier ages, exposing them to the adverse effects of excess body fat over a longer period of time. Obesity and poor eating habits can lead to all the major chronic diseases.
The good news is that people have some control over whether they develop chronic diseases. Every day people can make choices that increase or decrease their risks. These
chronic diseases A disease that develops and continues over a long period of time, such as heart disease or cancer.
TERMS
lifestyle choice A conscious behavior that can increase or decrease a person’s risk of disease or injury; such behaviors include decisions regarding smoking, eating a healthy diet, exercising, and using alcohol.
lifestyle choices include decisions regarding smoking, diet, exercise, sleep, and alcohol use. Table 1.2 shows the estimated number of annual deaths tied to selected underlying causes. For example, the estimated 90,000 deaths due to alcohol include deaths due directly to alcohol poisoning as well as alcohol-related deaths from liver cancer and accidents. As Table 1.2 makes clear, lifestyle factors contribute to many deaths in the United States, and people can influence their own health risks. The need to make good choices is especially true for teens and young adults. For Americans aged 15–24, for example, the leading cause of death is unintentional injuries (accidents), with the greatest number of deaths linked to car crashes (Table 1.3).
FIGURE 1.4
SOURCE: National Center for Health Statistics, 2016. “Healthy People 2020,” Midcourse Review, Hyattsville, MD.
Leading Causes of Death in the United States, 2015
Key D Diet plays a part S Smoking plays a part I Inactive lifestyle plays a part A Excessive alcohol use plays a part O Obesity is a contributing factor
NOTE: Although not among the overall top 10 causes of death, HIV/AIDS (6,465 deaths in 2015) is a major killer. In 2015, HIV/AIDS was the 13th leading cause of death for Americans aged 15–24 years and the 9th leading cause of death for those aged 25–34 years.
SOURCE: Centers for Disease Control and Prevention. 2017. 10 Leading Causes of Death by Age Group, United States, 2015. Web-based Injury Statistics Query and Reporting System (www.cdc.gov/injury/wisqars); Centers for Disease Control and Prevention. 2016. Cause of Death 1999-2015 on CDC WONDER Online Database (http://wonder.cdc.gov/ucd-icd10.html).
National Health
Wellness is a personal concern, but the U.S. government has financial and humanitarian interests in it, too. A healthy population is the nation’s source of vitality, creativity, and wealth. Poor health drains the nation’s resources and raises health care costs for all.
A Plan for National Health Care Total health care expenditures in the United States are the highest in the world and growing; by 2016, they exceeded $10,000 per person each year, including both out-of-pocket payments by individuals and costs paid by private and government health insurance. These costs are not distributed evenly across individuals, and people’s healthcare costs may vary significantly from year to year. Health insurance helps people pay for routine preventive care and protects them financially in the event of a serious and expensive illness or injury. Many people obtain health insurance through an employer, while others qualify for governmentsponsored programs, such as Medicare, which covers nearly all adults age 65 and older. Still, the United States over time has had a high number of people who lacked insurance, peaking at approximately 50 million (16% of the population) in 2010. People without insurance are less likely to receive preventive care or treatment for major health problems.
The 2010 Affordable Care Act (ACA), also called “Obamacare,” aimed to both reduce the number of uninsured and control the rise in healthcare costs. It mandated that most people obtain health insurance or pay a federal penalty. It
provided financial assistance for people with low incomes by expanding Medicaid (a joint federal/state insurance program) and by providing tax credits and income-based subsidies for people who obtained insurance through newly established insurance exchanges. The ACA also broadened requirements for all health insurance plans, including those offered by employers; these provisions allowed young adults to stay on their parents’ plans until age 26, eliminated annual and lifetime coverage limits, capped annual out-of-pocket payments, and provided protections for people with pre-existing conditions.
According to the National Center for Health Statistics, between 2010 and 2016, the overall number of Americans without insurance dropped by 20 million, down to 9% of the population, the lowest rate in decades. In 2016, among adults age 18-64 years, about 12% were uninsured (down from 22% in 2010), 20% were covered under a government-sponsored health plan, and 69% were covered by private insurance, including about 5% using an ACA insurance exchange. Defenders of the ACA argue that in addition to reducing the number of people without insurance, the act slowed the rise in health care costs and increased quality of care through changes in payment structures and delivery methods. Detractors of the law cite higher premiums and fewer insurance options as reasons to repeal and replace some or all of the law.
At this writing, major changes to the law have been proposed by Congress, and debate is ongoing about the costs and benefits of key ACA provisions. The ACA insurance requirements and expansion set new benchmarks for this debate over national health care policy.
Table 1.2
Key Contributors to Death among Americans
Leading Causes of Death among Americans Aged 15–24, 2015 Table
*The number of deaths due to obesity is an area of ongoing controversy and research. Recent estimates have ranged from 112,000 to 400,000.
**Microbial agents include bacterial and viral infections, such as influenza, pneumonia, and hepatitis. Infections transmitted sexually are counted in the “sexual behavior” category, including a proportion of deaths related to hepatitis, which can be transmitted both sexually and nonsexually.
***Drug overdose deaths have increased rapidly in recent years, making it likely that this estimate will rise.
****Estimated deaths linked to sexual behavior include deaths from cervical cancer and sexually acquired HIV, hepatitis B, and hepatitis C.
SOURCES: Kochanek, K. D., et al. 2016. “Deaths: Final data for 2014,” National Vital Statistics Reports 65(4).; National Research Council, Institute of Medicine, Measuring the Risks and Causes of Premature Death: Summary of Workshops, 2015. Washington, DC: National Academies Press; Stahre, M., et al. 2014. “Contribution of excessive alcohol consumption to deaths and years of potential life lost in the United States,” Preventing Chronic Disease: Research, Practice, and Policy 11: 130293; U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.
The Healthy People Initiative The national Healthy People initiative aims to prevent disease and improve Americans’ quality of life. Healthy People reports, published each decade since 1980, set national health goals based on 10-year agendas. The initiative’s most recent iteration, Healthy People 2020, was released to the public in 2010. Healthy People 2020 envisions “a society in which all people live long, healthy lives” and proposes the eventual achievement of the following broad national health objectives:
• Eliminate preventable disease, disability, injury, and premature death. This objective involves taking more concrete steps to prevent diseases and injuries, promoting healthy lifestyle choices, improving the nation’s preparedness for emergencies, and strengthening the public health infrastructure.
• Achieve health equity, eliminate disparities, and improve the health of all groups. This objective involves
*Poisoning deaths in this age group are primarily due to drug and alcohol overdose.
SOURCE: Centers for Disease Control and Prevention. 2017. 10 Leading Causes of Death by Age Group, United States, 2015. Web-based Injury Statistics Query and Reporting System (www.cdc.gov/injury/wisqars).
identifying, measuring, and addressing health differences between individuals or groups that result from social or economic disadvantage. (See the box “Wellness Issues for Diverse Populations.”)
• Create social and physical environments that promote good health for all. This objective involves the use of health interventions at many levels (such as anti-smoking campaigns by schools, workplaces, and local agencies), providing a broader array of educational and job opportunities for undereducated and poor Americans, and actively developing healthier living and natural environments for everyone.
• Promote healthy development and healthy behaviors across every stage of life. This goal involves taking a cradle-to-grave approach to health promotion by encouraging disease prevention and healthy behaviors in Americans of all ages.
In a shift from the past, Healthy People 2020 emphasizes the importance of health determinants—factors that affect the health of individuals, demographic groups, or entire populations. Health determinants are social (including factors such as ethnicity, education level, and economic status) and environmental (including natural and human-made environments). Thus, one goal is to improve living conditions in ways that reduce the impact of negative health determinants.
Table 1.4 shows examples of individual health promotion goals from Healthy People 2020, as well as estimates of how well Americans are achieving those goals. To gain an idea of
d IVER s IT y MATTER s Wellness Issues for Diverse Populations
We all need to exercise, eat well, manage stress, and cultivate positive relationships. Protecting ourselves from disease and injuries is important, too. But some of our differences—both as individuals and as members of groups—have important implications for wellness. These differences can be biological (determined genetically) or cultural (acquired as patterns of behavior through daily interactions with family, community, and society). Many health conditions are a function of biology and culture combined. You share patterns of influences with others; and information about groups can be useful in identifying areas that may be of concern to you and your family. Wellness-related differences among groups can be described in terms of a number of characteristics, including the following:
Sex and Gender. Sex represents the biological and physiological characteristics that define men, women, and intersex people. In contrast, gender refers to how people identify themselves and also the roles, behaviors, activities, and attributes that a given society considers appropriate. A person’s gender is rooted in biology and physiology, but it is shaped by experience and environment—how society responds to
individuals based on their sex. Examples of gender-related characteristics that affect wellness include the higher rates of smoking and drinking found among men and the lower earnings found among women compared with men doing similar work. Although men are more biologically likely than women to suffer from certain diseases (a sex issue), men are less likely to visit their physicians for regular exams (a gender issue). Men have higher rates of death from injuries, suicide, and homicide, whereas women are at greater risk for Alzheimer’s disease and depression. Men and women also differ in body composition and certain aspects of physical performance.
Race and Ethnicity. Although the concept of race is complex, with the number of people who identify themselves as biracial or multiracial growing, it is still useful to identify and track health risks among population groups. Some diseases are concentrated in certain gene pools, the result of each racial or ethnic group’s relatively distinct history. Diabetes is more prevalent among individuals of Native American or Latino heritage, for example, and African Americans have higher rates of hypertension. Racial and ethnic groups may vary in their
traditional diets; their family and interpersonal relationships; their attitudes toward tobacco, alcohol, and other drugs; and their health beliefs and practices.
Income and Education. Of all the variables, inequalities in income and education are the most highly correlated to health status. Income and education are closely related, and groups with the highest poverty rates and least education have the worst health status. These Americans have higher rates of infant mortality, traumatic injury, violent death, and many diseases. They are more likely to eat poorly, be overweight, smoke, drink, and use drugs. They are exposed to more day-to-day stressors and have less access to health care services.
In Table 1.1, notice how many causes of death are related to lifestyle. This is an excellent motivator for adopting healthy habits and staying in good condition. Maintaining physical fitness and a healthy diet can lead to a longer life. It’s a fact!
how you can make these national goals your own, visit www .healthypeople.gov. There you can find organizations that have affiliated themselves with Healthy People 2020, as well as publications and other resources detailing what it takes to get healthy.
Behaviors That Contribute to Wellness
A lifestyle based on good choices and healthy behaviors maximizes quality of life. It helps people avoid disease, remain strong and fit, and maintain their physical and mental health as long as they live.
Be Physically Active The human body is designed to be active. It readily adapts to nearly any level of activity and exertion. Physical fitness is a set of physical attributes that allows
the body to respond or adapt to the demands and stress of physical effort. The more we ask of our bodies, the stronger and more fit they become. When our bodies are not kept active, they deteriorate: Bones lose density, joints stiffen, muscles become weak, and cellular energy systems degenerate. To be truly well, human beings must be active.
Unfortunately, a sedentary lifestyle is common among Americans. According to a 2013 survey, only about half of adult Americans met the federal physical activity guidelines in 2013 (150 minutes or more per week of moderate aerobic exercise or 75 minutes per week of vigorous aerobic exercise). The older the adults, the less likely they were to meet the guidelines.
The benefits of physical activity are both physical and mental, immediate and long term (Figure 1.5). In the short term, being physically fit makes it easier to do everyday tasks, such as lifting; it provides reserve strength for emergencies; and it helps people look and feel good. In the long term, being physically fit confers protection against chronic diseases and lowers the risk of dying prematurely. (See the box “Does Being Physically Active Make a Difference in How Long You Live?”) Physically active people are less likely to develop or die from heart disease, respiratory disease, high blood pressure, cancer, osteoporosis, and type 2 diabetes (the most common form of diabetes). As they get older, they may be able to avoid weight gain, muscle and bone loss, fatigue, and other problems associated with aging.
Choose a Healthy Diet In addition to being sedentary, many Americans have a diet that is too high in calories, unhealthy fats, and added sugars, as well as too low in fiber, complex carbohydrates, fruits, and vegetables. Like physical inactivity, this diet is linked to a number of chronic diseases. A healthy diet provides necessary nutrients and sufficient energy without also providing too much of the dietary substances linked to diseases.
Maintain a Healthy Body Weight Overweight and obesity are associated with a number of disabling and potentially fatal conditions and diseases, including heart disease, cancer, and type 2 diabetes. Researchers estimate that obesity kills between 112,000 and 400,000 Americans each year. Healthy body weight is an important part of wellness—but short-term dieting is not part of fitness or wellness. Maintaining a healthy body weight requires a lifelong commitment to regular exercise, a healthy diet, and effective stress management.
Manage Stress Effectively Many people cope with stress by eating, drinking, or smoking too much. Others don’t deal with it at all. In the short term, inappropriate stress management can
physical fitness A set of physical attributes that allows the body to respond or adapt to the demands and stress of physical effort.
lead to fatigue, sleep disturbances, and other symptoms. Over longer periods of time, poor stress management can lead to less efficient functioning of the immune system and increased susceptibility to disease. Learning to incorporate effective stress management techniques into daily life is an important part of a fit and well lifestyle.
Avoid Tobacco and Drug Use and Limit Alcohol
Consumption Tobacco use is associated with 9 of the top 10 causes of death in the United States; personal tobacco use and secondhand smoke kill nearly 500,000 Americans each year, more than any other behavioral or environmental factor. In 2015, 15% of adult Americans described themselves as current smokers. Lung cancer is the most common cause of cancer death among both men and women and one of the leading causes of death overall. On average, the direct health care costs associated with smoking exceed $170 billion per year. If the cost of lost productivity from sickness, disability, and premature death is included, the total exceeds $300 billion.
Excessive alcohol consumption is linked to 8 of the top 10 causes of death and results in about 90,000 deaths a year in the United States. The social, economic, and medical costs of alcohol abuse are estimated at more than $250 billion per year. Alcohol or drug intoxication is an especially notable factor in the death and disability of young people, particularly through unintentional injuries (such as drownings and car crashes caused by drunken driving) and violence.
Protect Yourself from Disease and Injury The most effective way of dealing with disease and injury is to prevent them. Many of the lifestyle strategies discussed here help protect you against chronic illnesses. In addition, you can take specific steps to avoid infectious diseases, particularly those that are sexually transmitted.
Take Other Steps toward Wellness Other important behaviors contribute to wellness, including these:
• Increased endurance, strength, and flexibility
• Healthier muscles, bones, and joints
• Increased energy (calorie) expenditure
• Improved body composition
• More energy
• Improved ability to cope with stress
• Improved mood, higher self-esteem, and a greater sense of well-being
• Improved ability to fall asleep and sleep well
• Developing meaningful relationships—for example, learning to communicate and dealing with anger
• Planning for successful aging—for example, anticipating physical challenges and maintaining hobbies
• Learning about the health care system—for example, knowing what treatment options are available to you
• Acting responsibly toward the environment—for example, helping to reduce pollution and encouraging sustainable practices
Wellness Factors That Seem Outside Our Control
Heredity, the environment, and adequate health care are other important influences on health and wellness. These factors can interact in ways that raise or lower the quality of a person’s life and the risk of developing particular diseases. For example, a sedentary lifestyle combined with a genetic predisposition for diabetes can greatly increase a person’s risk of developing the disease. If this sedentary, genetically predisposed person also lacks adequate health care, he or she is much more likely to suffer dangerous complications from diabetes.
But in many cases, behavior can tip the balance toward health even if heredity or environment is a negative factor. Breast cancer, for example, can run in families, but it is also associated with overweight and a sedentary lifestyle. A woman with a family history of breast cancer is less likely to die from the disease if she controls her weight, exercises, and has regular mammograms to help detect the disease in its early, most treatable stage.
College Students and Wellness
• Reduced risk of dying prematurely from all causes
• Reduced risk of developing and/or dying from heart disease, diabetes, high blood pressure, and colon cancer
• Reduced risk of becoming obese
• Reduced anxiety, tension, and depression
• Reduced risk of falls and fractures
• Reduced spending for health care
Each year, thousands of students lose productive academic time to activities causing stress and other physical and emotional health problems—some of which can continue for a lifetime. According to the fall 2016 American College Health Association National College Health Assessment II, the following were commonly reported factors affecting academic performance:
• Stress (32.2% of students affected)
• Anxiety (24.9%)
• Sleep difficulties (20.6%)
• Depression (15.4%)
• Work (14.2%)
• Cold/flu/sore throat (13.0%)
• Concern for a troubled friend/family member (10.1%)
• Internet use/computer games (9.0%)
injury An injury that occurs without harm being intended.
FIGURE 1.5 Benefits of regular physical activity.
Does Being Physically Active Make a Difference in How Long You Live?
How can we be sure that physical activity and exercise are good for our health? To answer this question, the U.S. Department of Health and Human Services asked a committee to review scientific literature. The committee’s mission was to determine if enough evidence exists to warrant the government making physical activity recommendations to the public. The committee’s report, the Physical Activity Guidelines Advisory Committee Report, 2008, summarizes the scientific evidence for the health benefits of regular physical activity and the risks of sedentary behavior. The report provides the rationale for the federal government’s physical activity guidelines, and its findings were confirmed in the Scientific Report of the 2015 Dietary Guidelines Committee.
The Physical Activity Guidelines Advisory Committee started by asking whether physical activity actually helps people live longer. The committee investigated the link between physical activity and all-cause mortality—deaths from all causes—by looking at 73 studies dating from 1995 to 2008. The studies included men and women from all age groups (16 to 65+) and from different racial and ethnic groups.
The data from these studies strongly support an inverse relation between physical activity and all-cause mortality; that is, physically active people were less likely to die during a study’s follow-up period (ranging from 10 months to 28 years).
The review found that active people have about a 30% lower risk of dying compared with inactive people. These inverse associations were found not just for healthy adults but also for older adults (age 65 and older); for people with coronary artery disease, diabetes, or impaired mobility; and for people who were overweight or obese. Poor fitness and low physical activity levels were found to be better predictors of premature death than smoking, diabetes, or obesity. Based on the evidence, the committee determined that
Each of these factors is related to one or more dimensions of wellness, and most can be influenced by choices students make daily. For example, there are many ways to manage stress: By reducing unhealthy choices, such as using alcohol to relax, and by increasing healthy choices, such as using time-management techniques, even busy students can reduce the impact of stress. What about wellness choices in other areas? The American College Health Association survey found the following:
about 150 minutes (2.5 hours) of physical activity per week is enough to reduce all-cause mortality (see Chapter 2 for more details). It appears that it is the overall volume of energy expended, no matter which kinds of activities are done, that makes a difference in risk of premature death.
The committee also looked at whether there is a doseresponse relation between physical activity and all-cause mortality—that is, whether more activity reduces death rates even further. Again, the studies showed an inverse relation between these two variables. So, more activity above and beyond 150 minutes per week produces greater benefits. Surprisingly, for inactive people, benefits are seen at levels below 150 minutes per week. In fact, any increase in physical activity resulted in reduced risk of death. The committee refers to this as the “some is good; more is better” message. A target of 150 minutes per week is recommended, but any level of activity below the target is encouraged for inactive people.
Looking more closely at this relationship, the committee found that the greatest risk reduction is seen at the lower end of the physical activity spectrum (30–90 minutes per week). In fact, sedentary people who become more active have the greatest potential for improving health and reducing the risk of premature death. Additional risk reduction occurs as physical activity increases, but at a slower rate. For example, people who engaged in physical activity 90 minutes per week had a 20% reduction in mortality risk compared with inactive people, and those who were active 150 minutes per week, as noted earlier, had a 30% reduction in risk. But to achieve a 40% reduction in mortality risk, study participants had to be physically active 420 minutes per week (7 hours).
A 2017 American Heart Association report projected that cardiovascular disease costs in the United States will exceed $1 trillion by 2035. Regular exercise reduces the risk of cardiovascular disease and related health problems such as hypertension, high cholesterol, and diabetes. The message from the research is clear: It doesn’t matter what activity you choose or even how much time you can devote to it per week, as long as you get moving!
SOURCE: American Heart Association. 2017. Cardiovascular Disease: A Costly Burden for America; Projections through 2035. Dallas, TX: American Heart Association; 2015 Dietary Guidelines Advisory Committee. 2015. Scientific Report of the 2015 Dietary Guidelines Advisory Committee. Washington, DC: U.S. Department of Health and Human Services; Physical Activity Guidelines Advisory Committee, Physical Activity Guidelines Advisory Committee Report, 2008. Washington, DC: U.S. Department of Health and Human Services.
How often do you feel exuberant? Vital? Joyful? What makes you feel that way? Conversely, how often do you feel downhearted, de-energized, or depressed? What makes you feel that way? Have you ever thought about how you might increase experiences of vitality and decrease experiences of discouragement?
• Only 48.4% of sexually active students reported that they used a condom mostly or always during vaginal intercourse in the past 30 days.
• About 18.3% of students had seven or more drinks the last time they partied.
• About 11.7% of students used one or more prescription drugs that were not prescribed to them within the past year.
• About 10.1% of students smoked cigarettes, and 4.3% used e-cigarettes, at least once during the past month.
How do your daily wellness choices compare to those of other students? What is recommended to promote wellness? Remember: The sooner you trade an unhealthy behavior for a healthier one, the longer you’ll be around to enjoy the benefits.
REACHIng WEllnEss THRougH lIFEsT ylE MAnAgEMEnT
Moving in the direction of wellness means cultivating healthy behaviors and working to overcome unhealthy ones. This approach to lifestyle management is called behavior change. As you may already know from experience, changing an unhealthy habit can be harder than it sounds. When you embark on a behavior change plan, it may seem like too much work at first. But as you make progress, you will gain confidence in your ability to take charge of your life. You will also experience the benefits of wellness—more energy, greater vitality, deeper feelings of appreciation and curiosity, and a higher quality of life.
The rest of this chapter outlines a general process for changing unhealthy behaviors that is backed by research and has worked for many people. You will also find many specific strategies and tips for change. For additional support, work through the activities in the Behavior Change Workbook at the end of the text.
Getting Serious about Your Health
Before you can start changing a wellness-related behavior, you have to know that the behavior is problematic and that you can change it. To make good decisions, you need information about relevant topics and issues, including what resources are available to help you change.
Examine Your Current Health Habits
Consider how your current lifestyle is affecting your health today. How will it affect your health in the future? Do you know which of your current habits enhance your health and which ones may be harmful? Begin your journey toward wellness with self-assessment: Think about your own behavior, complete the self-assessment in Lab 1.2, and talk with friends and family members about what they’ve noticed about your lifestyle and your health. Digital trackers can also help with your self-assessment; see the box “Quantify Yourself.”
Choose a Target Behavior
Changing any behavior can be demanding. This is why it’s a good idea to start small, by choosing one behavior you want to change—called a target
behavior—and working on it until you succeed. Your chances of success will be greater if your first goal is simple, such as resisting the urge to snack between classes. As you change one behavior, make your next goal a little more significant, and build on your success over time.
Learn about Your Target Behavior After you’ve chosen a target behavior, you need to learn its risks and benefits for you—both now and in the future. As a starting point, use this text and the resources listed in the For Further Exploration section at the end of each chapter; see the box “Evaluating Sources of Health Information” for additional guidelines. Ask these questions:
• How is your target behavior affecting your level of wellness today?
• Which diseases or conditions does this behavior place you at risk for?
• What effect would changing your behavior have on your health?
Find Help Have you identified a particularly challenging target behavior or mood—something like overuse of alcohol, binge eating, or depression—that interferes with your ability to function or places you at a serious health risk? If so, you many need help to change behaviors or conditions that are too deeply rooted or too serious for self-management. Don’t be discouraged by the seriousness or extent of the problem; many resources are available to help you solve it. On campus, the student health center or campus counseling center can provide assistance. To locate community resources, consult yellowpages.com, your physician, or the Internet.
Building Motivation to Change
Knowledge is necessary for behavior change, but it isn’t usually enough to make people act. Millions of people have sedentary lifestyles, for example, even though they know it’s bad for their health. To succeed at behavior change, you need to be motivated and to know that even though an active lifestyle may be inconvenient, it may be required.
Examine the Pros and Cons of Change Health behaviors have short-term and long-term benefits and costs. Consider the benefits and costs of an inactive lifestyle:
• Short-term. Such a lifestyle allows you more time to watch TV and hang out with friends, but it leaves you less fit and less able to participate in recreational activities.
behavior change A lifestyle management process that involves cultivating healthy behaviors and working to overcome unhealthy ones.
target behavior An isolated behavior selected as the object of a behavior change program.
WE lln E ss I n THE d I g ITA l Ag E Quantify Yourself
You feel stressed and under the weather. How can you feel better? Do you have a habit you want to kick. Where to start?
People’s increasing desire to track their moods, sleep, exercise, and diet patterns has brought about some 165,000 health-related apps and movements, like Quantified Self—a California-based company that promotes self-tracking tools among communities across the world. By giving you numerical data related to your daily behaviors, digital trackers provide objective feedback about what is going on with your health. The technology also helps you describe your behaviors to doctors and can be integrated with behavior change strategies learned through counseling. Here are three steps to making good use of technology for wellness:
1. Monitor yourself. How much are you smoking? Sleeping? Exercising? What are you eating? Digital trackers can help answer these questions for you. A wristband can record whether you are getting enough restful sleep. Your smartphone can tell you how many steps you took to get across campus.
2. Analyze your data. You’ve tracked your sleep, your blood pressure, and your steps. You’ve kept a journal related to your diet. You’ve taken your body measurements. What patterns do you notice? What time of day do you tend to need food? Cigarettes? Sleep? How do your patterns match up with your goals?
Standard weight-loss apps allow users to input weight goals and monitor progress toward those goals; more sophisticated apps can analyze users’ data and offer daily physical-activity goals, or help them establish a regular eating schedule. You can now find advice, education, e-mail reminders, alerts for lapses in progress, motivational messages, and journals to record and track negative emotion. Many weightloss apps also link to social media for encouragement and
Wellness Tip Look for behavior-change support if you need it. Certain health behaviors are exceptionally difficult to change. Some people can quit smoking on their own; others get help from a smoking cessation program or a nicotine replacement product.
social support, or rewarding games and challenges. Additional features can be critical; tracking alone isn’t sufficient for successful behavior change. You need to apply change strategies such as those described later in the chapter.
3. Extend the list of behaviors you’d like to change. You can track more than just your diet and exercise habits with digital assistance. Electronic devices and smart programs are available to help with many aspects of wellness, including the following:
● Stress management
● Meditation and spirituality
● Heart rate and respiration
● Menstrual cycles
● Family medical history
● Journaling
With so many possibilities, how do you choose what to monitor? Start with one or two variables. The interactive labs at the end of each chapter focus on aspects of fitness and wellness to get you going. Also, you’ll find a variety of digital devices and apps discussed in later chapters, in “Wellness in the Digital Age” boxes. You may find one or more apps (many of which are free) that appeal to you and can help you make progress toward your fitness and wellness goals.
SOURCES: IMS Institute for Healthcare Informatics. September 17, 2015. IMS health study: Patient options expand as mobile healthcare apps address wellness and chronic disease treatment needs. (http://www.imshealth.com /en/about-us/news/ims-health-study:-patient-options-expand-as-mobilehealthcare-apps-address-wellness-and-chronic-disease-treatment-needs); and Schoeppe, S., et al. 2016. “Efficacy of interventions that use apps to improve diet, physical activity and sedentary behaviour: A systematic review,” International Journal of Behavioral Nutrition and Physical Activity, 13(127).
• Long-term. This lifestyle increases the risk of heart disease, cancer, stroke, and premature death.
To successfully change your behavior, you must believe that the benefits of change outweigh the costs.
Carefully examine the pros and cons of continuing your current behavior and of changing to a healthier one. Focus on the effects that are most meaningful to you, including those tied to your personal identity and values. For example, engaging in regular physical activity and getting adequate sleep can support an image of yourself as an active person who is a good role model for others. To work toward being independent and taking control over your life, quitting smoking can be one way to eliminate a dependency. To complete your analysis, ask friends and family members about the effects of your behavior on them. For example, a younger sister may tell you that your smoking habit influenced her decision to take up smoking.
The short-term benefits of behavior change can be an important motivating force. Although some people are motivated by
CRITICA l C onsu MER
Evaluating Sources of Health Information
Surveys indicate that college students are smart about evaluating health information. They trust the health information they receive from health professionals and educators and are skeptical about popular information sources, such as magazine articles and websites.
How smart are you about evaluating health information? Here are some tips.
General Strategies
Whenever you encounter health-related information, take the following steps to make sure it is credible:
● Go to the original source. Media reports and social media posts often simplify the results of medical research. Find out for yourself what a study really reported, and determine whether it was based on good science. What type of study was it? Was it published in a recognized medical journal? Was it an animal study, or did it involve people? Did the study include a large number of people? What did the study’s authors actually report?
● Watch for misleading language. Reports that tout “breakthroughs” or “dramatic proof” are probably hype. A study may state that a behavior “contributes to” or is “associated with” an outcome, but this does not prove a cause-and-effect relationship.
● Distinguish between research reports and public health advice. Do not change your behavior based on the results of a single report or study. If an agency such as the National Cancer Institute urges a behavior change, however, you should follow its advice. Large, publicly funded organizations issue such advice based on many studies, not a single report.
● Remember that anecdotes are not facts. A friend may tell you he lost weight on some new diet, but individual success stories do not mean the plan is truly safe or effective. Do any scientific studies back up the claims of the article?
● Be skeptical. If a report seems too good to be true, it probably is. Be wary of information contained in advertisements. An ad’s goal is to sell a product, even if there is no need for it, and sometimes even if the product has not been proven to be safe or effective.
● Make choices that are right for you. Friends and family members can be a great source of ideas and inspiration, but you need to make health-related choices that work best for you.
Internet Resources
Online information sources pose special challenges. When reviewing a health-related website, ask these questions:
● What is the source of the information? Websites maintained by government agencies, professional associations, or established academic or medical institutions are likely to present trustworthy information. Many other groups and individuals post accurate information, but it is important to look at the qualifications of the people who are behind the site. (Check the home page or click the “About Us” link.) Verify information you get from social media by visiting the originating organization’s website and evaluating the source.
● How often is the site updated? Look for sites that are updated frequently. Check the “last modified” date of any web page. Newer studies may contradict the results of earlier ones.
● Is the site promotional? Be wary of information from sites that sell specific products, use testimonials as evidence, appear to have a social or political agenda, or ask for money.
● What do other sources say about a topic? Be wary of claims and information that appear at only one site or come from a chat room, bulletin board, or blog. Do other authors cite the same studies as the ones in this article?
● Does the site conform to any set of guidelines or criteria for quality and accuracy? Look for sites that identify themselves as conforming to some code or set of principles, such as those set forth by the Health on the Net Foundation or the American Medical Association. Medical and health journals that have been peer reviewed (edited by experts in the field), and websites maintained by government agencies, professional associations, or established academic or medical institutions are most likely to present trustworthy information.
long-term goals, such as avoiding a disease that may hit them in 30 years, most are more likely to be moved to action by shorter-term, more personal goals. Feeling better, doing better in school, improving at a sport, reducing stress, and increasing self-esteem are common short-term benefits of health behavior change. Many wellness behaviors are associated with immediate improvements in quality of life. For example, surveys of Americans have found that nonsmokers feel healthy and full of energy more days each month than do smokers, and they report fewer days of sadness and troubled sleep. The same is
true when physically active people are compared with sedentary people. Over time, these types of differences add up to a substantially higher quality of life for people who engage in healthy behaviors.
Boost Self-Efficacy When you start thinking about changing a health behavior, a big factor in your eventual success is whether you have confidence in yourself and in your ability to change. Self-efficacy refers to your belief in your ability to successfully take action and perform a specific task. Strategies for
boosting self-efficacy include developing an internal locus of control, using visualization and self-talk, and getting encouragement from supportive people.
LOCUS OF CONTROL Who do you believe is controlling your life? Is it your parents, friends, or school? Is it “fate”? Or is it you? Locus of control refers to the figurative “place” a person designates as the source of responsibility for the events in his or her life. People who believe they are in control of their own lives are said to have an internal locus of control. Those who believe that factors beyond their control determine the course of their lives are said to have an external locus of control.
For lifestyle management, an internal locus of control is an advantage because it reinforces motivation and commitment. An external locus of control can sabotage efforts to change behavior. For example, if you believe that you are destined to die of breast cancer because your mother died from the disease, you may view screening mammograms as a waste of time. In contrast, if you believe that you can take action to reduce your risk of breast cancer in spite of hereditary factors, you will be motivated to follow guidelines for early detection of the disease.
If you find yourself attributing too much influence to outside forces, gather more information about your wellness-related behaviors. List all the ways that making lifestyle changes will improve your health. If you believe you’ll succeed, and if you recognize that you are in charge of your life, you’re on your way to wellness.
VISUALIZATION AND SELF-TALK One of the best ways to boost your confidence and self-efficacy is to visualize yourself successfully engaging in a new, healthier behavior. Imagine yourself going for an afternoon run three days a week or no longer smoking cigarettes. Also visualize yourself enjoying all the short-term and long-term benefits that your lifestyle change will bring. Create a new self-image: What will you and your life be like when you become a regular exerciser or a nonsmoker?
You can also use self-talk, the internal dialogue you carry on with yourself, to increase your confidence in your ability to change. Counter any self-defeating patterns of thought with more positive or realistic thoughts: “I am a strong, capable person, and I can maintain my commitment to change.” See Chapter 10 for more on self-talk.
ROLE MODELS AND OTHER SUPPORTIVE INDIVIDUALS
Social support can make a big difference in your level of
self-efficacy The belief in one’s ability to take action and perform a specific task.
Fitness
Tip Visualization is such a powerful technique that Olympic athletes learn how to harness it for peak performance. It works for average people, too. Set a small fitness goal, then imagine yourself doing it—as clearly and as often as you can. Visualization can help you believe in yourself, and belief can be a step toward success!
motivation and your chances of success. Perhaps you know people who have reached the goal you are striving for; they could be role models or mentors, providing information and support for your efforts. Gain strength from their experiences, and tell yourself, “If they can do it, so can I.” In addition, find a buddy who wants to make the same changes you do and who can take an active role in your behavior change program. For example, an exercise partner can provide companionship and encouragement when you might be tempted to skip your workout.
Identify and Overcome
Barriers
to Change Don’t let past failures at behavior change discourage you; they can be a great source of information you can use to boost your chances of future success. Make a list of the problems and challenges you faced in any previous behavior change attempts. To this list, add the short-term costs of behavior change that you identified in your analysis of the pros and cons of change. After you’ve listed these key barriers to change, develop a practical plan for overcoming each one. For example, if you always smoke when you’re with certain friends, decide in advance how you will turn down the next cigarette you are offered.
Enhancing Your Readiness to Change
TERMS
locus of control The figurative “place” a person designates as the source of responsibility for the events in his or her life.
self-talk A person’s internal dialogue
The transtheoretical, or “stages-of-change,” model is an effective approach to lifestyle self-management. According to this model, you move through distinct stages as you work to change your target behavior. It is important to determine what stage you are in now so that you can choose appropriate strategies for progressing through the cycle of change. (Figure 1.6) This
approach can help you enhance your readiness and intention to change. Read the following sections to determine what stage you are in for your target behavior.
Precontemplation People at this stage do not think they have a problem and do not intend to change their behavior. They may be unaware of the risks associated with their behavior or may deny them. They may have tried unsuccessfully to change in the past and may now think the situation is hopeless. They may also blame other people or external factors for their problems. People in the precontemplation stage believe that there are more reasons or more important reasons not to change than there are reasons to change.
Contemplation People at this stage know they have a problem and intend to take action within six months. They acknowledge the benefits of behavior change but worry about the costs of changing. To be successful, people must believe that the benefits of change outweigh the costs. People in the contemplation stage wonder about possible courses of action but don’t know how to proceed. There may also be specific barriers to change that appear too difficult to overcome.
Preparation People at this stage plan to take action within a month or may already have begun to make small changes in their behavior. They may be engaging in their new, healthier behavior but not yet regularly or consistently. They may have created a plan for change but may be worried about failing.
Action During the action stage, people outwardly modify their behavior and their environment. The action stage requires the greatest commitment of time and energy, and people in this stage are at risk for reverting to old, unhealthy patterns of behavior.
Maintenance People at this stage have maintained their new, healthier lifestyle for at least six months. Lapses may have occurred, but people in maintenance have been successful in quickly reestablishing the desired behavior. The maintenance stage can last for months or years.
Termination People at the termination stage have exited the cycle of change and are no longer tempted to lapse back into their old behavior. They have a new self-image and total self-efficacy with regard to their target behavior. For ideas on changing stages, see the box “Tips for Moving Forward in the Cycle of Behavior Change.”
Dealing with Relapse
People seldom progress through the stages of change in a straightforward, linear way. Rather, they tend to move to a new stage and then slip back to a previous stage before resuming their forward progress. Research suggests that most people
Relapse—slipping back to a previous stage—is a common part of the cycle of change
k i n g About It
FIGURE 1.6 The stages of change: A spiral model.
SOURCE: Centers for Disease Control and Prevention. (n.d.) PEP guide: Personal empowerment plan for improving eating and increasing physical activity. Dallas, TX: The Cooper Institute.
make several attempts before they successfully change a behavior; four out of five people experience some degree of backsliding. For this reason, the stages of change are best conceptualized as a spiral in which people cycle back through previous stages but are further along in the process each time they renew their commitment.
If you experience a lapse—a single slip—or a relapse—a return to old habits—don’t give up. Relapse can be demoralizing, but it is not the same as failure. Failure means stopping before you reach your goal and never changing your target behavior. During the early stages of the change process, it’s a good idea to plan for relapse so that you can avoid guilt and self-blame and get back on track quickly. Follow these steps:
1. Forgive yourself. A single setback isn’t the end of the world, but abandoning your efforts to change could have negative effects on your life.
2. Give yourself credit for the progress you have already made. You can use that success as motivation to continue.
3. Move on. You can learn from a relapse and use that knowledge to deal with potential setbacks in the future.
Developing Skills for Change: Creating a Personalized Plan
Once you are committed to making a change, put together a plan of action. Your key to success is a well-thought-out plan
TAKE CHAR g E Tips for Moving Forward in the Cycle of Behavior Change
Precontemplation
● Raise your awareness. Research your target behavior and its effects.
● Be self-aware. Look at the mechanisms you use to resist change, such as denial or rationalization. Find ways to counteract these mechanisms.
● Seek social support. Friends and family members can help you identify target behaviors and understand their impact on the people around you.
● Identify helpful resources. These might include exercise classes or stress-management workshops offered by your school.
Contemplation
● Keep a journal. A record of your target behavior and the circumstances that elicit the behavior can help you plan a change program.
● Do a cost-benefit analysis. Identify the costs and benefits (both current and future) of maintaining your behavior and of changing it. Costs can be monetary, social, emotional, and so on.
● Identify barriers to change. Knowing these obstacles can help you overcome them.
● Engage your emotions. Watch movies or read books about people with your target behavior. Imagine what your life will be like if you don’t change.
● Create a new self-image. Imagine what you’ll be like after changing your target behavior. Try to think of yourself in new terms right now.
● Think before you act. Learn why you engage in the target behavior. Determine what “sets you off” and train yourself not to act reflexively.
Preparation
● Create a plan. Include a start date, goals, rewards, and specific steps you will take to change your behavior.
that sets goals, anticipates problems, and includes rewards. This plan includes the following steps:
1. Monitor your behavior and gather data. Keep a record of your target behavior and the circumstances surrounding it. Record this information for at least a week or two. Keep your notes in a health journal or notebook or on your smartphone or computer (see the sample journal entries in Figure 1.7). Record each occurrence of your behavior, noting the following:
• What the activity was
● Make change a priority. Create and sign a contract with yourself.
● Practice visualization and self-talk. These techniques can help prepare you mentally for challenging situations.
● Take short steps. Successfully practicing your new behavior for a short time—even a single day—can boost your confidence and motivation.
Action
● Monitor your progress. Keep up with your journal entries.
● Change your environment. Make changes that will discourage the target behavior—for example, getting rid of snack foods or not stocking the refrigerator with beer.
● Find alternatives to your target behavior. Make a list of things you can do to replace the behavior.
● Reward yourself. Rewards should be identified in your change plan. Give yourself lots of praise, and focus on your success.
● Involve your friends. Tell them you want to change, and ask for their help.
● Don’t get discouraged. Real change is difficult.
Maintenance
● Keep going. Continue using the positive strategies that worked in earlier stages.
● Be prepared for lapses. Don’t let slip-ups set you back.
● Be a role model. After you have successfully changed your behavior, you may be able to help someone else do the same thing.
If relapses keep occurring or if you can’t seem to control them, you may need to return to a previous stage of the behavior change process. If this is necessary, reevaluate your goals and your strategy. A different or less stressful approach may help you avoid setbacks when you try again.
• When and where it happened
• What you were doing
• How you felt at that time
If your goal is to start an exercise program, track your activities to determine how to make time for workouts.
2. Analyze the data and identify patterns. After you have collected data on the behavior, analyze the data to identify patterns. When are you most likely to overeat? To skip a meal? What events trigger your appetite? Perhaps you are
